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Abusive head injury in the very young: outcomes from a Singapore children’s hospital

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Abstract

Purpose

Abusive head trauma (AHT) is a serious problem in children. The aims of this study are to identify risk factors that correlate with outcomes for those requiring neurosurgical intervention for very young children with AHT, assessment of variables associated with outcomes, and corroboration of our results with literature.

Methods

This is an ethics-approved, retrospective study. Inclusion criteria consisted of patients aged 2 years old or less with a diagnosis of AHT managed by the Neurosurgical Service, KK Women’s and Children’s Hospital. Demographical and clinical variables are incorporated in the statistical analyses. Logistic regression was applied to statistically significant variables for the risk prediction model.

Results

From 2000 to 2020, 24 patients required surgery for AHT. Timepoint was set at 12 months post-diagnosis. Univariate analyses demonstrated that patients with mild TBI were likely to have a favourable GOS-E Peds (p = 0.01), whereas radiological presence of cerebral oedema (p < .001), development of scar epilepsy (p = 0.021), and progression to cerebral palsy (p = 0.001) were associated with unfavourable GOS-E Peds.

Conclusion

This is the first study focused on neurosurgical outcomes for very young children with AHT in Singapore. We advocate multidisciplinary efforts to improve outcomes for this devastating condition.

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Author information

Authors and Affiliations

  1. Neurosurgical Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Nishal Kishinchand Primalani, Wan Tew Seow & Sharon Y. Y. Low

  2. Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Block MD11, Clinical Research Centre, #02-03 (c/o CBmE Office), 10 Medical Drive, Singapore, 117597, Singapore

    Yiong Huak Chan

  3. Neurology Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore

    Zhi Min Ng

  4. Children’s Emergency, KK Women’s and Children’s Hospital, Singapore, Singapore

    Shu-Ling Chong

  5. Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore

    Wan Tew Seow & Sharon Y. Y. Low

  6. SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    Wan Tew Seow & Sharon Y. Y. Low

  7. Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Lik Eng Loh & Yee Hui Mok

Authors
  1. Nishal Kishinchand Primalani
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  2. Yiong Huak Chan
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Correspondence to Sharon Y. Y. Low.

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All the authors certify that this manuscript is a unique submission and is not being considered for publication, in part or in full, with any other source in any medium. All authors made substantial contributions to the manuscript and approved its final version. We report no competing interests, funding, financial support or industrial affiliations received for the writing of this article. Also, we declare no conflict of interest concerning the material or methods used in this paper.

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Primalani, N.K., Chan, Y.H., Ng, Z.M. et al. Abusive head injury in the very young: outcomes from a Singapore children’s hospital. Childs Nerv Syst 38, 2397–2407 (2022). https://doi.org/10.1007/s00381-022-05572-x

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  • DOI: https://doi.org/10.1007/s00381-022-05572-x

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